H. Basir. Fisk University.
We would like to extend our appreciation to the staff in Mekelle University generic 50mg sumatriptan fast delivery spasms under rib cage, College of Health Sciences that v facilitated the process of the preparation of this Manual discount sumatriptan 50mg line muscle relaxant 5mg. Outline for preparing epidemic 183 preparedness and response plan of xiii epidemic prone diseases Annex 2 sumatriptan 25 mg lowest price muscle relaxant half-life. Recommended case definitions 201 for use by health facilities and by community Annex 7 discount sumatriptan 50 mg mastercard muscle relaxant non prescription. Some diseases are usually present in a community at a certain predictable level; this level is called the expected level. Terms for occurrence of disease at excess of the expected level include: - Epidemic - Pandemic - Outbreak - Cluster A term for irregular and occasional occurrence of disease: - Sporadic 1. Occurrence of disease at expected level include: An endemic disease is a disease that occurs in a population with predictable regularity and with only minor deviations from its expected frequency of occurrence. It is vital to note that a disease may be 2 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia endemic in a population at any frequency level, provided that it occurs with predictable regularity. Additional terms can be used to describe endemic diseases according to their frequency of occurrence: Hyperendemic is an endemic disease that affects a high proportion of the population at risk. Occurrence of disease at excess of the expected level include: Epidemic refers to the occurrence of disease or health related condition in excess of the usual frequency in a given area or among a specified group of people over a particular period of time. Epidemic of Measles, epidemic of obesity, epidemic of drug addiction, epidemic of rape etc The minimum number of cases that fulfils the criteria for epidemic is not specific and the threshold may vary E. One case of Small pox or Avian Human Influenza may constitute an epidemic Knowledge of the expected number is crucial to label an occurrence of a particular event as an epidemic Excess occurrence will have no meaning if there is no known expected level The expected level varies for different diseases and different geographic locations. Outbreak of gastroenteritis after sharing a common meal at an event A cluster is an unusual aggregation of health events in a given area over a particular period. The emphasis in case of a cluster is aggregation in a certain locality than the actual number of cases. For instance, three or four cases of a certain illness might occur in a certain kebele, while no cases occur in all other kebeles of a certain district. In this case, the number of cases might not be sufficient to constitute an epidemic. But, the occurrence in the particular kebele may be better referred to as a cluster. Other examples include: the cluster of cases of cholera in London investigated by John Snow, the cluster of cases of Angiosarcoma (a rare liver cancer) in workers of one factory led to identification of vinyl chloride as potent carcinogen. Irregular and occasional occurrence of disease: Sporadic refers to occasional or irregular occurrence of disease. A sporadic disease is a disease that is normally absent from a population but which can occur in that population, although rarely and without predictable regularity. Among the above diseases malaria and typhus frequently occur as epidemic when the environment or the host favours their occurrence. Cholera, yellow fever and 6 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia meningococal meningitis often occur as epidemics in Ethiopia. Examples of sporadic diseases in Ethiopia include colonic cancer, Parkinson s disease, etc. Types of epidemic Three types are well recognized: Common source Propagated/progressive and Mixed. Common source epidemics Common source epidemic is a type of epidemic caused by exposure of a group of people to a common risk factor, such as an infectious agent or a toxin or a chemical, etc. This can take two form: i- Point source epidemic If the exposure is brief and simultaneous, all exposed will develop the disease within one incubation period referred to as point source epidemic/outbreak. Example: food borne 7 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia outbreak of Acute Gastro Enteritis in attendants of a wedding feast. A waterborne outbreak that is spread through a contaminated community water supply can be an example 1. Propagated or progressive epidemics Outbreak of this type occurs from transmission of an infectious agent from one susceptible an infected host to another. It can be through: Direct person-to-person transmission or Indirect transmission: through a vector, vehicle, etc. Mixed Epidemic Mixed epidemics is an epidemic which shows the features of both types of epidemics (common and propagated). It usually begins with a common source of infectious agent with subsequent propagated spread, e. It is an important component of epidemiology and public health, which through a systematic way helps in identifying the source of 10 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia ongoing outbreaks and in preventing additional cases. First there is great urgency to find out the source and prevent additional cases and also a substantial pressure to conclude rapidly, particularly if the outbreak is ongoing, which may lead to hasty decisions regarding the source of the outbreak with negative consequences on the success of control measures. Second the involvement of many agencies and the fact that outbreak investigation is carried out at many levels pose a threat to undertake a well coordinated work. In many outbreaks, the number of cases available for study is limited; therefore, the statistical power of the investigation is also limited. Possible outbreaks of disease come to the attention of public health officials in various ways. Review of routinely collected surveillance data can detect outbreaks of known diseases, through regular analysis and interpretation, if 11 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia there is a strong and quality surveillance system in place b. Often, observant clinicians, infection control nurses, or clinical laboratory workers first notice an unusual disease or an unusual number of cases of a disease and alert public health officials. Frequently, it is the patient (or someone close to the patient) who first suspects a problem, as is often the case in food borne outbreaks after a shared meal d. Sometimes public health officials learn about outbreaks of disease from the local newspaper or television news. The most compelling reason to investigate a recognized outbreak of disease is that exposure to the source(s) of infection may be continuing; the investigation provides helpful information to take immediate action i. Because the results of the investigation may lead to recommendations or strategies for preventing similar future outbreaks, thereby improving long term disease prevention activities. For some communicable diseases, a single suspected case might suffice to start the process of investigation. For instance diseases with a potential for massive epidemics or diseases caused by etiologic agents of high virulence need more attention and alertness than others. Such diseases need 13 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia immediate investigation followed by immediate response. The steps to follow are set by the individual investigator depending on the suspected cause of the outbreak. Collect laboratory specimens and obtain laboratory results 14 Manual on Investigation and Management of Epidemic Prone Diseases in Ethiopia 5. Verify that there is an epidemic Reports about presence of epidemics are not always correct and one of the crucial tasks in epidemic investigation is verifying whether there is really an epidemic or not. This is particularly important when considering the resources that would be expended for an artifactual rise in the number of cases or deaths. Verifying the diagnosis in the index case/s In order to verify the suspected epidemic, one might start by verifying the diagnosis in the index case(s). This is done by reviewing clinical and laboratory findings in index cases to establish diagnosis. Index cases are important because they indicate the possible start of an outbreak; the sooner the index case and other early cases are identified and diagnosed, the higher the chance of arresting the epidemic. However, it should be noted that the notion of index cases might not be valid in case of diseases which normally occur at a predictable regularity and that occasionally occur in excess of their expected frequency. Compare current occurrence with the expected occurrence: The other essential task of verifying an epidemic is to compare the current number of cases with the past levels of disease in that community, considering the seasonal variation in the occurrence of the disease. Rule out artifactual changes in the occurrence of the disease: Even if there seems to be an apparent excess in the number of cases or deaths due to a disease, still potential causes of a false-rise exist and should be looked for. In such situations, the following three considerations should be done in order to declare an epidemic. For example diseases like viral hemorrhagic fever pose a serious threat to the public because of extremely high risk for disease wider transmission in contrast to diseases like neonatal tetanus which pose less threat to the public.
The mesangial matrix is expanded and there There are three main types of diabetic neuropathy: r Symmetrical peripheral neuropathy: Affecting sen- are round hyaline areas in the glomeruli (Kimmelstiel- Wilson nodules) discount sumatriptan 50mg with mastercard muscle relaxant for bruxism. Focal nerve palsies may be Management due to sudden occlusion of a larger vessel causing in- Improving glycaemic control may be of benet sumatriptan 25 mg mastercard 3m muscle relaxant. Feet should be inspected and examined at each review including sensation to a 10 g monolament A diffuse symmetrical pattern of damage to the nerves cheap 50mg sumatriptan free shipping spasms while high, or vibration and palpation of foot pulses discount sumatriptan 25mg otc spasms with broken ribs. Examination most commonly the sensory nerves, which has a glove may need to be repeated 1 3 monthly in high-risk pa- and stocking distribution. New ulceration, swelling, discolouration is a foot myelin degeneration and axonal damage. Sensory neuropathy: r Sensory symptoms in the feet and legs are most com- Prognosis mon and may be insidious or sudden in onset. In the The acute form may resolve with time and better gly- case of the latter it may follow an episode of severe caemic control. The pain is worse at night and keeps Focal and multifocal neuropathy the patient awake. Investigations r Third nerve palsy typically presents with pain, A careful neurological examination should be carried diplopia and ptosis. The important differential diagnosis is a spinal or cauda equina cause of the radiculopathy. Complications Pyelonephritis, overgrowth of bowel bacteria causing di- Investigations arrhoea. Occasionally, it may be useful to exclude other Management causes, particularly in cranial nerve palsies when a space- Treatmentdependsonthesymptomsandcomplications. Postural hypotension is treatable with udrocortisone (a mineralocorticoid), but this may cause hypertension to be worse. Prognosis Symptomatic autonomic neuropathy is associated with Autonomic neuropathy areduced life expectancy. The hyperglycaemic and metabolic acidotic state which occursinTypeIdiabetesduetoexcessketoneproduction Pathophysiology as a result of insulin deciency. It is associated with bladder emptying, sexual function (erection and ejac- poor diabetic control. Life-threatening disturbances include reduced awareness of hypoglycaemia and cardiorespiratory ar- Pathophysiology rest. Infact,stressessuchasanintercur- r Postural hypotension, causing dizziness, faints and rent infection increase the secretion of glucagon and falls. Failure of ejaculation due to poses ketogenesis, but in conditions of insulin de- impaired sympathetic activity. Any un- cose concentrations rise, causing hyperosmolarity of derlying illness must be treated as appropriate. The renal threshold for glucose require a nasogastric tube for gastric decompression and reabsorption (10 mmol/L) is exceeded, and an os- emptying as there is a high risk of aspiration. Fluid and moticdiuresisoccurssothatwaterandelectrolytes,es- electrolytes: Patients can be as much as 10 L uid de- pecially sodium and potassium, are rapidly lost. Monitor uid balance causes a severe dehydration, hypovolaemia and this (urine output etc. A central venous compounds the problem by reducing renal perfusion, catheter may be placed to measure central venous pres- thereby reducing glucose clearance. Care must be taken not r Dehydration is exacerbated by vomiting, which is due to change the osmolality too rapidly, as this can lead to to central effects of ketosis. Replacement should be faster if Shock and acute renal failure, cerebral oedema may oc- patients are shocked and slower if there are signs of cur during rehydration, adult respiratory distress syn- cardiac failure, uid overload or cerebral oedema. Supplementa- tion is always needed, because potassium follows glu- Investigations cose into the cells. An arterial blood gas sample Insulin: Soluble insulin is administered intravenously by is also required to demonstrate and assess the severity of an infusion pump start with 10 units per hour and metabolic acidosis. Serum amylase greater than three- cutaneous or intramuscular insulin can reverse the ke- fold normal is suggestive of acute pancreatitis, which toacidosis. It therefore should not normally be used in the is rehydration and correction of electrolyte imbalances. It is the most common cause of death in diabetic patients under 20 Complications years old. Thromboembolic disease, such as stroke, mesenteric arterythrombosis,deepveinthrombosisandpulmonary embolism. Precipitating factors include infection, myocardial in- farction and stroke, or diabetogenic drugs such as glu- Management cocorticoids and thiazide diuretics. Patients require emergency uid resuscitation with nor- mal saline and potassium replacement (as for diabetic Pathophysiology ketoacidosis). Prophylactic low-dose heparin to prevent nesis, uncontrolled ketogenesis does not occur. Any underlying cause is insufcient insulin to prevent increased glucose pro- should be identied and treated. This compounds the hyperos- molarity caused by the hyperglycaemia, which increases Hypoglycaemia blood viscosity, predisposing to thromboembolic disor- Denition ders. If untreated, it leads to confusion and eventually Lowserumglucosecausedbyinsufcienthepaticglucose coma. Other tests causes include insulinomas (see page 222) and Addison s may be required to identify the underlying cause. Management Clinical features This is a medical emergency and requires immediate Patients become irritable, pale, weak and sweaty. Untreated the condition progresses to con- followed by a more complex carbohydrate to prevent fusion, seizures and coma. The diagnosis can be conrmed on bedside blood sugar r Further management depends on severity and the un- testing, a formal laboratory glucose sample should be derlying cause. Hypersplenism occurs when the spleen is func- Lymphadenopathy tionally overactive and can result from any cause of splenomegaly. The usual function of lymph nodes is to allow anti- gen recognition, proliferation and afnity maturation of mature lymphocytes. They usually become enlarged Bleeding tendency when active/reactive because of infection. Enlargement of lymph nodes can be localised or generalised (see Ta- Characterisation of a bleeding tendency requires multi- ble 12. Localised lymphadenopathy r Generalised haemostatic defects are suggested by Infection, e. It occurs in severe infections, tuber- blood vessels platelets and coagulation: culosis or malignant inltration of the bone marrow. This may result from marrow inltration or haemarthroses(bleedingintothejoints)andmuscle myelobrosis. It occurs with any cause of pancy- Investigations topenia, in association with rheumatoid arthritis (Felty s r Full blood count and blood lm to examine the num- syndrome). Alymphocytosis is seen in viral infections particularly r A full coagulation screen isperformed comprising a Epstein Barr virus and cytomegalovirus. An incision is made that is 1-cm long and Monocytes are the blood and bone marrow located pre- 1-mm deep. The time taken for bleeding to stop is cursors of tissue macrophages (including liver Kupffer measured.
The Committee received documentation from one Air Force pilot who suffered from serious symptoms of Gulf War Syndrome purchase sumatriptan 50mg with visa muscle relaxant baclofen. He sought medical treatment outside the military medical system and was tested for heavy metals best 50mg sumatriptan spasms down there, and was found to have toxic levels of mercury in his system buy sumatriptan 25 mg without a prescription muscle relaxant norflex. There Are Growing Questions About Whether Mercury In Childhood Vaccines Is Related To Autism Spectrum Disorders A generic sumatriptan 25mg with amex spasms leg. Introduction Autism was once considered a rare disease that affected an estimated 1 in 10,000 individuals in the United States. The Committee held its first hearing on the dramatic rise in autism in April of 2000. At the time, Federal agencies were estimating that autism affected 1 in 500 children in the United States. By 2002, the National Institutes of Health had adjusted that 55 rate to 1 in 250 children in the United States. The Autism Society of America estimates that the 56 number of autistic children is growing by 10 to 17 percent each year. Department of Education statistics, requests for services for school-age children with autism spectrum disorders had risen dramatically in every state. Burton: California has reported a 273 percent increase in children with autism since 1988... Maryland has reported a 513 percent increase between 1993 and 1998 In 1999, there were 2,462 children ages 3 to 21 in Indiana diagnosed with autism. That is one-fourth of 1 percent of all the school children in Indiana, or 1 out of every 400 This increase is not just better counting. I want to express my deep appreciation to you and to the members of the committee for allowing me to testify. I am presently treating over 300 autistic children, with an additional 150 waiting to get in. We are treating children from all over the United States and getting calls from many places around the globe. If you have any idea that 58 it is not, I invite you to sit in my office for 2 hours. The rate of autism among children in Brick Township was 4 per 1,000 (1 in 250) children aged 3 through 10 years. Their evaluation of the cause of the cluster of autism in Brick Township was inconclusive. These numbers were 10 times higher than studies conducted in the 1980s and early 1990s. Last November, a study on autism in California determined that the number of autistic individuals in that state has nearly tripled. Equally important, the study stated that the increase was real, and could not be explained by changes in diagnostic criteria or better diagnoses. The study, funded by the state legislature and conducted by the University of California at Davis, determined that the number of autistic people in that state grew by 273% between 1987 and 61 1998. Robert Byrd, said, It is astounding to see a three- fold increase in autism with no explanation there s a number of things that need to be answered. The Causes of the Autism Epidemic Are Not Known The underlying causes of the explosion in autism remains a mystery. While the medical community has made many advances over the years in developing treatments and better diagnostic tools, little progress has been made in understanding why some children become autistic. During the hearings held in this committee, we have heard parents tell tragic stories of children who appear to be developing normally and then all of a sudden retreat into themselves, stop communicating, and develop autistic behavior. Other parents have testified that their children never start to develop language skills, and instead early on manifest symptoms of autism. And I appreciate how urgently we need to understand what causes autism, how 64 to treat it, and if possible, how to prevent it. A One Year Update ; Hearing Before the Committee on Government th Reform; 107 Congress; April 25-26, 2001; Serial No. In 1954, Kanner said, "We have not encountered any one autistic child who came of unintelligent parents. Influenced by Kanner, pediatricians for decades were persuaded to blame mothers of autistic children for being cold and emotionally rejecting, causing the children in turn to coldly reject contact with other people. By 1954, Kanner began modifying his "Blame the Mother" position in light of evidence that brothers and sisters of autistic children were often well- adjusted, high functioning children. These findings suggested that the development of autism was also a result of genetic or "constitutional inadequacies" as well as bad parenting. However, psychoanalyst Bruno Bettleheim continued purporting the rejecting parent theme. Bettleheim, a holocaust death-camp survivor, insisted that the autistic child was behaving in abnormal ways in retaliation against a rejecting mother who had traumatized the child by failing to 65 provide enough love or attention. However, a California psychologist and father of an autistic child, Bernard Rimland, Ph. Bettleheim s theories through the publication of his landmark book Infantile Autism: The Syndrome and Its Implications for a Neural Theory of Behavior. Rimland methodically dismantled the psychoanalytic theory of autism and argued for a biological, specifically a neurological, basis for autistic behavior. Rimland documented the similarities between brain injured children and autistic children, liberating parents from the destructive guilt associated with having an autistic child and pointing autism research in the direction of investigating the biological mechanisms underlying the brain and immune dysfunction symptoms and their 66 possible causes. Some 36 years later, his databank includes information on more than 30,000 cases of autism from around the world. In analyzing the data for age of onset of autism, he discovered that before the early 1980 s, most of the parents reported their children first showed signs of abnormal behavior from birth or in the first year of life. The numbers of parents reporting that their children developed normally in the first year and a half of life and then suddenly became autistic doubled. Today, Rimland says that the onset-at-18-months 67 children outnumber the onset-at-birth children by 2 to 1. Nor is there any conclusive explanation for the rapid growth in cases of late-onset autism. Most experts believe that some combination of genetic and environmental factors must be at work. A leading and prominent theory is that the growing amount of mercury in childhood vaccines may have triggered an autistic response in children who are genetically predisposed to being vulnerable to mercury damage. The Alarming Growth in Autism Coincided with an Increase in the Number of Childhood Vaccines Containing Thimerosal on the Recommended Schedule. Through most of the twentieth century, individuals were required to receive very few vaccines. However, with the licensing of the Hepatitis B (Hep B) vaccine and the Haemophilus Influenzae Type b (Hib) vaccine starting in the mid-to-late 1980 s, and their subsequent recommendation for universal use in 1991, the amount of mercury to which infants were exposed rose dramatically. It was during this period of increased exposure to thimerosal and its ethylmercury component that the growing wave of late-onset autism became apparent. This confluence of events led many to suspect a correlation between the two and call for more research into the relationship between ethylmercury in vaccines and autism spectrum disorders. The ethylmercury in thimerosal would kill the living virus, making it unsuitable for such vaccines. The polysaccaride Haemophulus Influenzae B (Hib) vaccine was first licensed in 1985. It had 25 micrograms of ethylmercury and was given 3 times in the first six months of life (75 69 micrograms of ethylmercury) and a total of four times in the first two years of life. The approval of the Hep B vaccine in 1986 added another thimerosal-containing shot to the recommended schedule. As was noted previously, the effects of ethylmercury have not been studied as carefully as methylmercury, and the Federal Government has not established safety thresholds for ethylmercury exposure. This does not mean that injury would definitely occur above this level because a significant safety margin is built in.
The physical description of an audiovisual is optional in a reference but may be included to provide useful information purchase 25 mg sumatriptan overnight delivery spasms under ribs. Other information that also may be provided in the physical description is whether or not the journal is displayed in color or black and white 25 mg sumatriptan visa muscle relaxant 2265, or has sound buy sumatriptan 50 mg on line spasms in 8 month old. Continue to Citation Rules with Examples for Journal Titles in Audiovisual Formats purchase sumatriptan 25mg spasms compilation. Citation Rules with Examples for Journal Titles in Audiovisual Formats Components/elements are listed in the order they should appear in a reference. Box 51 Journals appearing in different editions If a journal is published in more than one edition: Capitalize all significant words in edition information Separate the edition from the title proper by a space and place it in parentheses End all title information with the medium of the journal, placed in square brackets, followed by a period Examples: Video Rivista Italiana di Gastroenterologia (Edizione Endoscopia Digestiva) [videocassette]. Journals in Audiovisual Formats 779 Treat a letter marked with diacritics or accents as if it were not marked treated as A treated as O treated as C treated as L treated as a treated as g treated as n treated as u Treat two or more letters printed as a unit (ligated letters) as if they were two letters treated as ae treated as oe To help identify editions in other languages, below is a brief list of Non-English words for editions with their abbreviations, if any (n. Dutch Uitgave Uitg Editie Ed Finnish Julkaisu Julk French Edition Ed German Ausgabe Ausg Greek Ekdosis Ekd Italian Edizione Ed Norwegian Publikasjon Pub Portuguese Edicao Ed Russian Izdanie Izd Spanish Edicion Ed Swedish Upplaga n. Audiovisual journal title with edition Type of Medium for Journal Titles in Audiovisual Formats (required) General Rules for Type of Medium Indicate the type of medium (audiocassette, videocassette, etc. Standard audiovisual journal title that has ceased publication Editor for Journal Titles in Audiovisual Formats (optional) General Rules for Editor Give the name of the current (or last) editor Enter the name of the editor in natural order. Audiovisual journal title with unknown place of publication Publisher for Journal Titles in Audiovisual Formats (required) General Rules for Publisher Record the name of the publisher as it appears in the journal, using whatever capitalization and punctuation are found there Abbreviate well-known publisher names with caution to avoid confusion. Box 59 Multiple publishers If a journal has changed publishers over the years, give the name of the current (or last) publisher If more than one publisher is found in a document, use the first one given or the one set in the largest type or set in bold Journals in Audiovisual Formats 785 An alternative is to use the publisher likely to be most familiar to the audience of the reference list, e. For publications with joint or co-publishers, use the name provided first as the publisher and include the name of the second as a note, if desired, such as "Jointly published by the Canadian Pharmacists Association". Audiovisual journal title with publisher having subsidiary part Volume Number for Journal Titles in Audiovisual Formats (required) General Rules for Volume Number Precede the number with "Vol. Philadelphia: American Law Institute- American Bar Association Committee on Continuing Professional Education. Audiovisual journal title without volume or issue numbers Issue Number for Journal Titles in Audiovisual Formats (required) General Rules for Issue Number Precede the issue number with "No. Box 66 No issue number present If no issue number is present but a volume number can be found, follow the publisher with the volume number and beginning date Waltham forum video for small animal practitioners [videocassette]. Box 67 Options for issues If a journal began publishing with volume one, number one, you may omit the issue number: Gastroenterology [audiocassette]. Audiovisual journal title without volume or issue numbers Date of Publication for Journal Titles in Audiovisual Formats (required) General Rules for Date of Publication Include the month and year the journal began to be published, in that order, such as May 2004 Convert roman numerals to arabic numbers. Enter closing volume and issue information followed by a comma and the closing month and year. Journals in Audiovisual Formats 789 Box 69 Non-English names for months Translate names of months into English Abbreviate them using the first three letters Capitalize them Examples: mayo = May luty = Feb brezen = Mar Box 70 Seasons instead of months Translate names of seasons into English Capitalize them Do not abbreviate them Examples: balvan = Summer outomno = Fall hiver = Winter pomlad = Spring Separate multiple seasons by a hyphen, such as Fall-Winter Spring-Summer 1994 - Fall-Winter 1995. Box 71 Options for dates If both volume and issue numbers are present, you may omit the name of the months or seasons: Practical Reviews in Dermatology [audiocassette]. Audiovisual journal title with season in date 790 Citing Medicine Physical Description for Journal Titles in Audiovisual Formats (optional) General Rules for Physical Description Enter the medium on which the audiovisual title is issued, in plural form, followed by a colon and a space. Example: Videocassettes: Give information on the physical characteristics of an audiovisual, such as color and size Specific Rules for Physical Description Language for describing physical characteristics Box 72 Language for describing physical characteristics Physical description of a journal in audiovisual format is optional in a reference but may be included to provide useful information to the reader. Examples: "Videocassettes:" and "Audiocassettes:" Include physical characteristics, such as color and size. Audiocassettes are produced in a number of other sizes, but the standard size is used for scientific journals. Size is usually omitted from the description of audiocassettes unless it deviates from the standard. The speed of the audiocassette, provided in terms of inches per second, is used in the description instead. Standard audiovisual journal title that has ceased publication Language for Journal Titles in Audiovisual Formats (required) General Rules for Language Give the language of publication if other than English Capitalize the language name Follow the language name with a period Specific Rules for Language Journals appearing in more than one language Box 73 Journals appearing in more than one language If a journal is published in multiple languages: Give the title in the first language found, in order of preference: on the opening screens of the issue, on the carrying case, or on accompanying print material Indicate all languages of publication after the date(s) of publication (and Physical Description if provided) Separate the languages by commas End the list with a period Example: Video-Revista de Cirugia [videocassette]. Audiovisual journal title published in multiple languages Notes for Journal Titles in Audiovisual Formats (optional) General Rules for Notes Notes is a collective term for any useful information about the journal itself 792 Citing Medicine If the journal was published under another title, provide the name preceded by "Continues: ". Specific Rules for Notes Other types of material to include in notes Box 74 Other types of material to include in notes The name under which a journal was previously published, preceded by. Sponsored by the Albert Einstein College of Medicine and Montefiore Medical Center. Audiovisual journal title with examples of other notes Examples of Citations to Journal Titles in Audiovisual Formats 1. Standard audiovisual journal title that is still being published Pulse: Emergency Medical Update [videocassette]. Standard audiovisual journal title that has ceased publication Leadership in Hospital Governance [videocassette]. Audiovisual journal title with edition Video Rivista Italiana di Gastroenterologia (Edizione Endoscopia Digestiva) [videocassette]. Audiovisual journal title not in English Video Rivista Italiana di Gastroenterologia (Edizione Endoscopia Digestiva) [videocassette]. Audiovisual journal title not in English, with optional translation Video Rivista Italiana di Gastroenterologia (Edizione Endoscopia Digestiva) [Italian Video Review of Gastroenterology (Digestive Endoscopy Edition)] [videocassette]. Audiovisual journal title published in multiple languages Video-Revista de Cirugia [videocassette]. Audiovisual journal title with well-known place of publication Audio Journal of Oncology [audiocassette]. Audiovisual journal title with lesser-known place of publication Medical Outlook for Infertility Specialists [audiocassette]. Audiovisual journal title with unknown place of publication European Video Journal of Cardiology [videocassette]. Audiovisual journal title with well-known publisher Equine Video Journal [videocassette]. Audiovisual journal title with publisher having subsidiary part Resource: a Monthly Audio Digest of Current Issues in Health Care Risk Management [audiocassette]. Audiovisual journal title with volume and issue number Video Journal of General Surgery [videocassette]. Audiovisual journal title with issue number, but no volume Perspectives: the Joint Commission Television Journal [videocassette]. Audiovisual journal title with multiple month(s) in date Practical Reviews in Dermatology [audiocassette]. Audiovisual journal title with days of the month included in date Gastroenterology [audiocassette]. Audiovisual journal title with season in date Equine Video Journal [videocassette]. Audiovisual journal title previously published under another name Clinical Advances in Cardio-respiratory Care [audiocassette]. Audiovisual journal title continuing to be published under another name Dynamic Cardiovascular Imaging [videocassette]. Audiovisual journal title with sponsorship note Audio Journal of Oncology [audiocassette]. Audiovisual journal title with frequency of publication note Waltham Forum Video for Small Animal Practitioners [videocassette]. Audiovisual journal title with note on a library where it may be located Leadership in Hospital Governance [videocassette]. Audiovisual journal title with distributor note European Video Journal of Cardiology [videocassette]. Audiovisual journal title accompanied by other types of material Pulse: Emergency Medical Update [videocassette]. Audiovisual journal title with examples of other notes European Video Journal of Cardiology [videocassette]. Individual Prints and Photographs Sample Citation and Introduction Citation Rules with Examples Examples B.